Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet - Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.
Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet - Blegdamsvej, 2100, Copenhagen, Denmark.
J Headache Pain. 2022 Nov 19;23(1):145. doi: 10.1186/s10194-022-01520-x.
Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD.
We aimed to assess outcome and complications after microvascular decompression from our center.
We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors.
Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I - BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9-12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1-6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others.
Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively.
Clinical.
gov registration no. NCT04445766 .
三叉神经痛是一种严重的面部疼痛障碍。微血管减压术是治疗经典三叉神经痛患者的首选手术治疗方法。很少有前瞻性研究对微血管减压术后的疗效和并发症进行独立评估。
我们旨在评估我们中心微血管减压术后的结果和并发症。
我们前瞻性地记录了连续接受微血管减压术治疗的经典或特发性（仅存在神经血管接触的患者）三叉神经痛患者的临床特征、结果和并发症。神经血管接触通过 3.0T MRI 进行评估。患者在手术前、手术后 3、6、12 和 24 个月由独立评估者进行评估。
在纳入的 115 名患者中，86%的患者有显著的临床疗效（即 BNI I - BNI IIIb）。手术效果极佳与男性（比值比 4.9（95%置信区间 1.9-12.8），p=0.001）和神经血管接触伴形态改变（比值比 2.5（95%置信区间 1.1-6.0），p=0.036）显著相关。女性（12/62=19%）比男性（2/53=4%）出现手术失败的比例更高，p=0.019。最常见的主要并发症是永久性听力损伤（10%）、永久性严重感觉减退（7%）、永久性共济失调（7%）和中风（6%）。大多数患者（94%）会向他人推荐手术。
微血管减压术是治疗经典和特发性（仅存在神经血管接触的患者）三叉神经痛的有效方法，具有长期效果的高几率。男性和经典三叉神经痛患者的良好手术效果几率最高。并发症相对常见，需要在术前对患者进行彻底的评估和信息提供。
